Cpa Firm Permit Renewal - Minnesota Board Of Accountancy - 2018 Page 3
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67.
List of Minnesota non-CPA owners:*
Provide the names of all non-CPA owners, partners, members, shareholders, directors and officers
of the firm who reside in Minnesota.
* Be sure to complete a
Non-CPA Owner of Firm Statement
(page 5) and enclose the $45.00 fee for each individual listed.
8.
Non-CPA owners—resident and nonresident combined—hold,
in
total, what percentage of:
Voting interest in the firm?
%
Financial interest in the firm?
%
9.
DESIGNATION AFFIDAVIT FOR
FIRM PERMIT RENEWAL
Read all statements and sign the affidavit below.
1. The firm has verified that two-thirds of all CPA owners, partners, shareholders, members, managers,
directors and officers of the firm who have their principal place of business located in Minnesota have an
active certificate for 2018.
2. All attest and compilation services rendered by the firm in this state are under the charge of a person
holding a valid certificate with an active status or a person who has been granted practice privileges
under Minnesota Statute §326A.14 (2016).
3. The firm has an audit documentation retention and destruction policy that complies with Minnesota
Rules 1105.7850.F (2015).
4. The firm has verified that—if applicable—all Minnesota non-CPA owners have completed a Minnesota
Non-CPA Owner of Firm Statement and registered with the Board.
5. All individual employees of the firm who have been granted practice privileges under Minnesota Statute
§326A.14 (2016), or who hold certificates and reside or practice in this state and those persons specified
in part 1105.4000.D (2015), who are responsible for supervising attest or compilation services or who
sign or authorize someone to sign an accountant’s report on financial statements have met the compe-
tency requirements set out in professional standards.
Affidavit: I swear or affirm that I have read the foregoing renewal application
and that the statements are true and complete.
Printed Name of Managing Partner/Shareholder/Officer
Signature of Managing Partner/Shareholder/Officer
Certificate Number
State of Issuance
Date
CPA Firm Permit Renewal Form—Page 2 of 5
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